Introduction Anaemia of chronic disease (ACD) is said to be associated with prolonged inflammation or infection, or malignancy. We sought to determine the yield of investigations in a cohort of patients referred to the outpatient clinic with blood tests compatible with ACD.
Methods We prospectively collected data on patients attending a single consultant led iron-deficiency anaemia (IDA) clinic, who did not fulfil the criteria for iron deficiency anaemia, from 2013–2015. These patients were investigated according to symptoms and blood tests by a single consultant physician.
Results A total of 371 patients were referred with the label of IDA. Iron deficiency anaemia was confirmed in 282 patients, and isolated iron deficiency in a further 11 patients, leaving 78 (21%) who did not fulfil the criteria and were deemed to have ACD (age range 45–92; 53 males). Thirty two (41%) were asymptomatic. Malignancy was discovered in 11 (14%) (colorectal 2, lung 2, prostate 2, combined gastric and colonic 1, gastric 1, renal 1, cervical 1, lymphoma 1). Three of the 11 patients with malignancy were asymptomatic (2 lung, 1 colonic). The majority (9/11) were evident on CT scanning of the chest, abdomen and pelvis. Other diagnoses responsible for ACD (23) were: chronic kidney disease (CKD) 7, haemoglobinopathy 3 (with associated CKD in 1), MGUS 3, myelodysplastic syndrome 2, low B12 2 (metformin in 1), haematoma 1, haemorrhagic gastritis 1, menorrhagia 1, pernicious anaemia 1, polymyalgia rheumatica 1, seronegative coeliac disease 1. No cause for the anaemia was found in 43 (56%) of the cohort.
Conclusion The prevalence of malignancy in ACD is high. Cross-sectional imaging as a first line investigation will pick up the majority of malignancies. CKD is a common cause of ACD. No cause of ACD is found in over half of patients.
Disclosure of Interest None Declared